Left Atrial Volume as Predictor of Valve Replacement and Cardiovascular Events in Patients with Asymptomatic Mild to Moderate Aortic Stenosis

Dalsgaard, Morten; Egstrup, Kenneth; Wachtell, Kristian; Cramariuc, Dana; Kjærgaard, Jesper; Gerdts, Eva; Hassager, Christian

doi:10.1111/echo.12184

Cited by 12 publications

(10 citation statements)

References 36 publications

(79 reference statements)

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“…21 Only 1 study has analyzed the outcome implications of indexed LAV in AS. 25 This report from the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study included only asymptomatic patients with mild-to-moderate AS and failed to demonstrate an association between indexed LAV and the combined end point of AVR, heart failure, and cardiac death. 25 We report a strong association between severe LA enlargement and mortality in a large cohort of patients with AS.…”

Section: Discussionmentioning

confidence: 92%

“…In a retrospective report of 622 patients with asymptomatic severe AS, LA diameter was reported to predict the occurrence of symptoms and mortality . Only 1 study has analyzed the outcome implications of indexed LAV in AS . This report from the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study included only asymptomatic patients with mild‐to‐moderate AS and failed to demonstrate an association between indexed LAV and the combined end point of AVR, heart failure, and cardiac death .…”

Section: Discussionmentioning

confidence: 99%

“…Data on the prognostic impact of LAV in a large spectrum of patients with AS are lacking. 25 Moreover, the role of LAV normalization to body size in refining LAV outcome prediction has never been investigated.…”

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confidence: 99%

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Left Atrial Volume and Mortality in Patients With Aortic Stenosis

Ruşinaru

Bohbot

Kowalski

et al. 2017

JAHA

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BackgroundLeft atrium (LA) enlargement is common in patients with aortic stenosis (AS), yet its prognostic implications are unclear. This study investigates the value of left atrial volume (LAV) and LAV normalized to body size for predicting mortality in AS.Methods and ResultsWe included 1351 patients with AS in sinus rhythm at diagnosis and analyzed the occurrence of all‐cause death during follow‐up with medical and surgical management. Five parameters of LA enlargement were tested: nonindexed LAV and normalized LAV by ratiometric (LAV/body surface area [BSA] and LAV/height) and allometric (LAV/BSA 1.7 and LAV/height2.0) scaling. For each parameter, patients in the highest quartile were at high risk of death, whereas outcome was better and similar for the other quartiles. Five‐year survival was lower for patients with LAV >95 mL and LAV/BSA >50 mL/m2 compared with those with no or mild LA enlargement (both P<0.001). After adjustment for established outcome predictors, including surgery, high risk of death was observed with LAV >95 mL (adjusted hazard ratio, 1.40 [95% confidence interval, 1.06–1.88]) and LAV/BSA >50 mL/m2 (adjusted hazard ratio, 1.42 [95% confidence interval, 1.08–1.91]). LAV/BSA and LAV showed good and similar predictive performance, whereas other scaling methods did not show better outcome prediction. In patients with severe AS at baseline, preserved (≥50%) ejection fraction, and no or minimal symptoms, LA enlargement was significantly associated with mortality (adjusted hazard ratio, 1.87 [95% confidence interval, 1.02–3.44] for LAV >95 mL, and adjusted hazard ratio, 1.90 [95% confidence interval, 1.03–3.56] for LAV/BSA >50 mL/m2).Conclusions LA enlargement is an important predictor of mortality in AS, incrementally to known predictors of outcome. LAV and LAV/BSA have comparable predictive performance and should be assessed in clinical practice for risk stratification.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Left Atrial Volume and Mortality in Patients With Aortic Stenosis

Ruşinaru

Bohbot

Kowalski

et al. 2017

JAHA

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“…Left atrium (LA) enlargement has proven to be a powerful predictor of adverse outcomes in several disease entities. [9][10][11] However, no data are available correlating TZ-related LV dysfunction to baseline left atrial volume index (LAVI). Therefore, the aim of this single-center observational study was to investigate the relationship between baseline LAVI and cardiotoxicity development, and to test the hypothesis that baseline LA volume enlargement could predict TZrelated LV dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Left atrial volume in patients with HER2‐positive breast cancer: One step further to predict trastuzumab‐related cardiotoxicity

Bergamini

Dolci

Rossi

et al. 2018

Clinical Cardiology

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BackgroundTrastuzumab (TZ) therapy requires careful monitoring of left ventricular (LV) ejection fraction (LVEF) because it can be potentially cardiotoxic. However, LVEF is an imperfect parameter and there is a need to find other variables to predict cardiac dysfunction early. Left atrium (LA) enlargement has proven to be a powerful predictor of adverse outcomes in several disease entities.HypothesisBaseline LA volume enlargement might predict TZ‐related LV dysfunction.MethodsHER2‐positive breast cancer patients receiving TZ and undergoing transthoracic echocardiography at baseline and at follow‐up every 3 months were retrospectively recruited. One‐hundred sixty‐two patients formed the study population.ResultsBaseline LAVI was dilated in 14 patients (8.6%). Mean follow‐up was 14 ± 4 months. Cardiotoxicity occurred in 24 patients (14.8%). LAVI was an independent predictor of TZ‐induced LV dysfunction in a clinical model, after adjustment for age and hypertension (odds ratio per 5‐mL/m2 LAVI increase: 1.34, 95% confidence interval: 1.03‐1.82, P = 0.03); and in a hemodynamic model, including ventricular sizes and systolic blood pressure level (odds ratio per 5‐mL/m2 LAVI increase: 1.34, 95% confidence interval: 1.01‐1.81, P = 0.04). The predicted probability of developing cardiotoxicity increased progressively, in parallel with LAVI values.ConclusionsBaseline LA dilatation emerges as a condition associated with the development of cardiotoxicity in HER2‐positive breast cancer patients treated with TZ.

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“…The development of HF symptoms in patients with AS has previously been demonstrated to be associated with degrees of AS severity and LV hypertrophy, 3 but HF symptoms in patients with AS often occur irrespective of AS severity and LVEF. On the other hand, it was recently reported that exercise performance is relevant for resting left atrium (LA) function, [4][5][6][7][8][9] and is also a quite important prognostic marker for patients with HF. 10,11 Changes in these structural and functional variables precede development of HF symptoms, are predictive of changes in clinical status.…”

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confidence: 99%